Whole lung lavage for the treatment of silicosis

Details

• Personal Author:
  Banks DE ; Benzo RP ; Castranova, Vincent ; Dedhia HV ; Huang H ; Lapp, N. Leroy ; Ma JKH ; Parker, John E. ; Shumaker J ; Stullken E ; Vallyathan V ; Weissman, David N. ; Wilt JL
• Description:
  Silicosis is an irreversible, chronic, progressive respiratory disease. No therapy has been proven to effectively modify the progression of silicosis. Whole lung lavage (WLL) is used in treating Pulmonary Alveolar Proteinosis but reported only once in the Western literature treatment for dust-induced lung disease. Recently physicians in China have used this therapy for pneumoconiosis in coal miners. The rationale for WLL in dust-induced lung disease is removal of activated cells, cytokines and dust-containing cells, all of which are likely contributing to the fibrosis. We performed WLL on a 53 year old motorman and roof bolter with significant silica exposure, ILO category 2 with coalescence chest radiograph, and normal pulmonary function. We also performed a segmental bronchoalveolar lavage (BAL) prior to and 10 days after the WLL on each side. WLL on the right lung consisted of 8 liters of saline, at which time he suffered a hydropneumothorax which led to premature termination of the procedure. A small catheter was inserted, the pneumothorax evacuated, and he was discharged the following day. Six weeks later, he underwent WLL on the left with 13 liters of saline without incident. Total cells recovered during WLL were 5.22 x 108 on the right and 3.91 x 108 on the left. Total macrophages recovered were 4.71 x 108 on the right (90% of total cells) and 3.70 x 108 on the left (94.6% of total cells). WLL removed 1.82 gm of mineral dust (non-coal) on the right and 1.64 gm on the left. Cytokine analysis paralleled the dust and radiographic findings of more disease on the right. Cultured alveolar macrophages from pre-WLL lavage released higher basal TNFa values on the right (213 pg/ml) versus left (28 pg/ml). With zymosan stimulation the levels increased to 331 pg/ml (right) and 213 pg/ml (left). Similar values were obtained for basal I1-lB, 322 pg/ml (right) and 18 pg/ml (left). Zymosan stimulated cells yielded 396 pg/ml from the right versus 115 pg/ml from the left lung. WLL appears to be a feasible means of removing dust, cytokines, and dust-laden cells that may reflect differential disease activity and allow modification of the progressive fibrosis that is associated with silica exposure. [Description provided by NIOSH]
• Subjects:
  Aluminum Silicates Coal Coal Mining Dust Environmental Exposure Fibrosis Lung Lung Diseases Mining Occupational Health Particulate Matter Respiratory System Respiratory Tract Diseases Risk Assessment Risk Factors Safety

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• Keywords:
  Alveolar Cells Coal Miners Cytokines Diseases Dust Exposure Dust Particles Exposure Levels Lung Disease Pneumoconiosis Pulmonary Disorders Pulmonary Function Pulmonary System Pulmonary System Disorders Respiratory Diseases Respiratory System Disorders Risk Factors Silicates Silicosis

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• ISSN:
  1073-449X
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Abstract or Summary
• Place as Subject:
  OSHA Region 3 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DRDS - Division of Respiratory Disease Studies
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  149
• Issue:
  4
• NIOSHTIC Number:
  nn:20047932
• Citation:
  Am J Respir Crit Care Med 1994 Apr; 149(4)(Pt 2):A405
• CAS Registry Number:
  Silica (CAS RN 7631-86-9)
• Federal Fiscal Year:
  1994
• Performing Organization:
  Center to Protect Workers' Rights
• Peer Reviewed:
  False
• Part Number:
  2
• Start Date:
  19900928
• Source Full Name:
  American Journal of Respiratory and Critical Care Medicine
• End Date:
  19970515
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:93bc08b07e7ca51e094dfc7568a61ba8041c38ed66cf55bdfc50332d5adbc819b0b5b02f88a9dc78fc005ce4dc89923d04abec6fb5d7fda13e369d2602ce5c19
• Download URL:
  https://stacks.cdc.gov/view/cdc/202865/cdc_202865_DS1.pdf
• File Type:
  [PDF - 1.37 MB ]